Healthcare Provider Details

I. General information

NPI: 1902011885
Provider Name (Legal Business Name): ROBERT NELSON HYDE III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NEW HAVEN AVE
DERBY CT
06418-2197
US

IV. Provider business mailing address

12 ROOSEVELT DR
SEYMOUR CT
06483-2117
US

V. Phone/Fax

Practice location:
  • Phone: 203-736-9214
  • Fax: 203-736-9172
Mailing address:
  • Phone: 203-736-6186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number023888
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number023888
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: